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A root canal is a treatment to save your natural tooth. If you are experiencing severe pain, or if your general dentist has recommended a root canal, our offices can help you.

A root canal involves removing infected pulp from inside the tooth. The pulp is a collection of nerves and blood vessels that build the tooth during childhood, but is mostly a way for your adult tooth to monitor for cracks and cavities. The need for a root canal can be caused by a variety of things, including decay, trauma, cracks, and more.

Once the pulp is removed, the canals of the tooth are cleaned and irrigated and the inside of the tooth is sealed. A temporary filling is placed, and you should visit your general dentist within two weeks for permanent restoration.

During the procedure, local anesthesia is used to relieve any discomfort you might feel.

Step 1:

An opening is made in the crown of the tooth.  This allows access to the root canal system.  It is very important to have a large enough opening to find all the canals inside a tooth.  Anatomy inside the tooth is variable.  Some teeth have just one canal like most upper front teeth.  Premolars usually have 1 or 2.  Molars or the back teeth typically have 3 or 4.   Especially in back teeth, a surgical operating microscope with great illumination allows visualization much better to help find these canals.

Step 2:

The pulp is removed from the pulp chamber and root canals.  Tiny instruments are used to clean the root canals and to shape them to a form that will be easy to fill.  Irrigants are used to dissolve and flush out debris.  If this step is not completed in one visit, medication will be placed in the canals and a temporary filling will be placed in the opening to protect the tooth between visits.  Radiographs (X-rays) are taken periodically during the cleaning process to check if the instruments are cleaning near the end of the root.

Step 3:

When thoroughly cleaned, the root canals are filled with a rubber-like compound called "gutta percha." A cement is also used to help seal the canals to prevent bacteria from re-entering.  In many cases, the opening in the crown of the tooth is sealed with a temporary filling.  Either upon the request from your dentist or when we feel it is appropriate, the access opening in the crown is filled with a build-up restoration as pictured.  Occasionally, enough tooth structure is missing to warrant use of a post to help retain the final restoration.  After endodontic treatment, x-rays are taken to verify that cleaning and filling of the canals is close to the end of the root.

Step 4:

If a temporary filling was placed, it will be replaced by your regular dentist with a permanent filling and restoration as needed.  A gold crown is shown for illustrative purposes, but tooth-colored crowns are often used.  Crowns are required on teeth towards the back of your mouth since the opening made weakens the top part of the tooth which undergoes tremendous stress during eating.  Front teeth may require restoration with a crown when not enough natural tooth structure is present but otherwise can often just be restored with a filling.  Your Endodontist will discuss the requirements of your specific case after your endodontic examination and treatment planning.

What kind of materials are placed in the process?

The resulting space inside the center portion of your tooth is filled with a rubber-like material (gutta percha) and cement (zinc oxide + eugenol) to seal the root canals in vast majority of cases.  In a few special cases, the root canal space may be filled with mineral trioxide aggregate (MTA) or a plastic resin.  If a filling is placed to restore an area, it will NOT contain amalgam but usually one or more of the following: composite/glass/resin ionomer (glass and organic acid +/or plastic resin), MTA (portland cement), +/or zinc oxide/eugenol.

What if I have a temporary or buildup placed after treatment?

If a temporary was placed after completion of treatment, it is imperative to return to your restorative dentist for treatment.  Because a temporary filling is designed to last only a short time (about four weeks), failing to return to your dentist as directed to have the tooth sealed permanently with a crown can lead to the deterioration of the seal, resulting in fracture, decay, infection, gum disease and/or the possible premature loss of the tooth and require additional treatment like another retreatment or extraction. 

If a build-up was placed after completion of treatment, it's important to return to your restorative dentist for completing the restoration of the tooth.  Failing to return to your dentist as directed can result in fracture of the tooth, which in some instances is not repairable and tooth will have to be extracted.  Other things can happen, such as the deterioration of the seal, decay, infection, gum disease and even the potentially premature loss of the tooth. 

If your temporary or build-up comes out, it needs to be replaced right away.  You have invested in maintaining the tooth, so return to your restorative dentist as soon as possible (within a month)!

On rare occasions, teeth that have gone through endodontic treatment may fail to heal properly, or pain may persist.

Improper Healing can be caused by:

• Canals not treated during the initial procedure
• Crown or restoration not being placed within the appropriate time period following the procedure
• An improper seal on a crown or restoration that allowed saliva to recontaminate the tooth

If this is the case, a consultation for endodontic retreatment is necessary.

Why does a retreatment always start with a consultation?

Not all teeth that have had a prior root canal are candidates for retreatment. For this reason our doctors will meet with you to set a treatment plan and take a ConBeam Scan.

What is a ConBeam scan and why is it needed?

A Con Beam scan is a 3D image of your tooth. This scan produces three dimensional (3-D) images of your tooth, soft tissues, nerve pathways and bone all in one scan. It provides much more information than traditional X-rays and is a very useful tool for diagnosis.

During the procedure, the infected tooth is reopened and the original restorative material is removed. Our doctors will thoroughly clean out all canals and carefully examine the inside of the tooth for any other issues. Once the inside of the tooth and canals have been thoroughly cleaned, they will be filled and sealed again. Return to your general dentist as soon as possible to restore the tooth permanently.

It used to be called a "root canal" until the American Association of Endodontists redesignated it "Non-surgical Endodontic Therapy."  It is the same thing, same basic process, same materials.  Instrumentation, irrigation and filling techniques have changed enough to have alleviated a lot of the "experiences" folks used to have with "root canal" treatment so the specialty decided to give the procedure a new name.

Why Do I Need It?

The pulp, or soft inner tissue is important during the tooth's development.  Once a tooth is fully mature, the tooth can survive without the pulp because the tooth is nourished by tissues surrounding it.  The pulp is normally surrounded and protected by a layer of dentin. 

Above the gumline, the dentin is protected by a layer of enamel; below the gumline, the dentin is covered by cementum. When a crack or cavity destroys these protective layers, the pulp is exposed to irritants and bacteria in your mouth. This can result in inflammation then infection, and, eventually, an abscess. Periodontal (gum) disease or a severe blow to the tooth can also damage the pulp. Endodontic therapy removes the damaged pulp and usually the tooth returns to a healthy condition.

If an abscess was present before treatment the healing process may take up to 2 years.

What Happens During Endodontic Treatment?

A local anesthetic will be given.  A sheet of latex called the "rubber dam" (we have non-latex ones too) will be placed around the tooth to isolate it, hence keeping it clean and dry during treatment.  The treatment consists of three or four basic steps, but the number of visits will depend on your particular case.  Some treatments take 2 visits but many are just a single visit.  Occasionally 3 appointments are needed.  In any case, it depends on the degree of infection/inflammation and degree of treatment difficulty. 

Because people are living longer and dentists are helping keep teeth longer, teeth are being exposed to years of crack inducing habits. Particularly, clenching, grinding and chewing hard things such as ice can result in cracks and fractures in teeth. Typically, teeth with cracks/fractures do not show on radiographs (x-rays). Hence, cracked and fractured teeth can especially be difficult to locate. When the outer hard tissues of a tooth are fractured or cracked, chewing can cause movement of the pieces and the pulp becomes irritated. Often this results in a momentary, sharp pain which eventually progresses to include thermal sensitivity. In time, the cracked or fractured tooth, similar to other teeth with pulp degeneration, can begin to hurt on its own.

Apexification is a treatment for a non-vital tooth with incomplete root formation. Apexification removes the unhealthy pulp and places calcium hydroxide into the root to stimulate the formation of hard tissue near the root tip. The hardened tissue provides a barrier for the root canal filling. Apexification with calcium hydroxide requires multiple treatments over a several-month period. Some people are candidates for an alternative method of apexification that can be performed in a single office visit. It involves placing the mineral trioxide aggregate (MTA) paste into the end of the root. We will recommend either the calcium hydroxide or MTA approach, based on your individual condition.

Injury to the face or mouth can cause serious problems for your teeth. Teeth can become dislodged or loose, pushed back into their sockets, or they can be completely knocked out. If this happens it is important that you seek treatment immediately. We treat a variety of problems that has resulted from traumatic dental injuries, such as tooth avulsion and dislodged teeth.

Injuries to the mouth can cause teeth to be pushed back into their sockets. In this situation, our doctors will consult to determine if root canal treatment is needed.

If an injury causes a tooth to be completely knocked out of your mouth, it is important that you seek treatment immediately! If this happens to you, keep the tooth moist. If possible, put it back into the socket. A tooth can be saved if it remains moist. You can even put the tooth in milk or a glass of water (add a pinch of salt.) We may start root canal treatment based upon the stage of root development. The length of time the tooth was out of your mouth and the way the tooth was stored may influence the type of treatment you receive.

A "toothache" is pain typically around a tooth, teeth or jaws. In most instances, toothaches are caused by a dental problem, such as a dental cavity, a cracked or fractured tooth, an exposed tooth root or gum disease.

Sometimes diseases of the jaw joint (temporomandibular joint), or spasms of the muscles used for chewing can cause toothache-like symptoms.

The severity of a toothache can range from chronic and mild to sharp and excruciating. It can be a dull ache or intense. The pain may be aggravated by chewing or by thermal foods and liquids which are cold or hot. A thorough oral examination, proper tooth testing and evaluation, along with appropriate dental x-rays, can help determine the cause. What we want to know is whether the toothache is really coming from a tooth or somewhere else.